• 142•国际脑血管病杂志202丨年 2 月第 29 卷第 2 期Int J Cerebrovasc Dis, February 2021，Vol. 29, No. 2•综述•依折麦布预防缺血性卒中谭燕张健中山大学附属第一医院神经内科，广东省重大神经疾病诊治研究重点实验室，国家临床重点专科和国家重点学科，广州510080通信作者：张健，Email:zhjian55@【摘要】血脂异常是卒中高危因素，降低低密度脂蛋内胆固醇（low-density lipoprotein chesterol,L D L-C)水平可降低缺血性卒中发病风险。
他汀类药物和PC SK9抑制剂均可有效降低L D L-C水平，但有些患者不能耐受他汀类药物，而P C SK9抑制剂则价格昂贵。
动物实验显示，依折麦布可通过激活腺苷酸活化蛋內激酶（AMP-activated protein kinase, AMPK)信号通路减轻氧化应激和内质网应激反应,抑制细胞凋亡，增加自噬，从而保护神经组织。
临床研究表明，依折麦布可在他汀类药物治疗基础上进一步降低L D L-C水平，降低急性冠状动脉综合征患者的缺血性卒中风险，且没有明显不良反应。
但是，对于年龄為75岁、L D L-C升高且没有冠心病的老年人，依折麦布则不能降低卒中发生率。
目前，依折麦布用于缺血性卒中二级预防的相关研究较少，其作用尚需大样本随机对照试验进一步证实。
【关键词】卒中；脑缺血;依折麦布；降血脂药;抗胆固醇血症药基金项目：国家重点研发计划项目（20丨7丫?(：1307501);广东省自然科学基金（20丨7人0303丨3575);广东省自然科学基金（2017A030310523);华南神经疾病早期干预及功能修复研究国际合作基地(2015B050501003);广东省神经系统重大疾病诊治.T程技术研究中心；广东省神经系统重大疾病诊治转化医学创新平台；广东省神经系统疾病临床医学研究中心DOl ： 10.3760/cm a.j.issn. 1673-4165.2021.02.011Ezetimibe in the prevention o f ischemic strokeTan Yan, Zhang JianDepartment o f Neurology, the First Affiliated Hospital o f Sun Yat-sen University; Guangdong Provincial KeyLaboratory for Diagnosis and Treatment o f Major Neurological Diseases, National Key Clinical Specialty andKey Discipline o f Neurology, Guangzhou, 510080, ChinaCorresponding author: Zhang Jian Email:******************n【Abstract】Dyslipidemia is a risk factor for stroke, and reducing low-density lipoprotein cholesterol(LDL-C) levels can decrease the risk o f ischemic stroke. Both statins and PCSK9 inhibitors can effectivelyreduce LDL-C levels, but som e patients cannot tolerate statins, and PCSK9 inhibitors are expensive. Animalexperiments have shown that ezetimibe can reduce oxidative stress and endoplasmic reticulum stressresponse, inhibit cell apoptosis, increase autophagy, and protect nerve tissue by activating AMP activatedprotein kinase (AMPK) signaling pathway. Clinical studies have shown that ezetimibe can further reduceLDL-C levels on the basis o f statin therapy, and reduce the risk o f ischemic stroke in patients with acutecoronary syndromes, and there is no obvious adverse reaction. However, ezetimibe cannot reduce theincidence o f stroke in elderly people who are ^75years old, have elevated LDL-C and do not have coronaryheart disease. At present, there are few studies on the use o f ezetimibe for secondary prevention o f ischemicstroke, and its effect needs to be further confirmed by large randomized controlled trials.【Key w ord s】Stroke; Brain ischemia; Ezetimibe; Hypolipidemic agents; Anticholesteremic agentsFund programs ： National Key R&D Program o f China (2017YFC1307501); Guangdong Natural ScienceFoundation o f China (2017A030310523, 2017A030313575 ); South China International Cooperation Base forEarly Intervention and Functional Rehabilitation o f Neurological Diseases (2015b05001003); GuangdongEngineering and Technology Research Center for Diagnosis and Treatment o f Major Nervous SystemDiseases; Guangdong Translational Medicine Innovation Platform for Diagnosis and Treatment o f Major国际脑血管病杂志2021 年 2 月第 29 卷第 2 期Int J Cerebrovasc Dis，February 2021, Vol. 29, No. 2•143•Nervous System Diseases; Guangdong Clinical Medicine Research Center for Nervous System DiseasesDOI ： 10.3760/cm a.j.issn. 1673^ 165.2021.02.011卒中是全世界范围内继缺血性心脏病之后的第 二大死亡原因，但在中国已成为首位死亡原因[|]。
